For the health IT industry, the silence is deafening. There's little that can be said about the looming release of meaningful use definitions for electronic health records that will be made public in about a month.
When National Coordinator for Health IT David Blumenthal gave the opening keynote at the College of Healthcare Information Management Executives 09 Fall Forum in California a couple of weeks ago, he emphasized that point before 550 attendees -- about 320 of them being CIOs at hospitals and integrated delivery systems. He couldn't discuss details of the parameters that health care providers' EHR systems will need to achieve to qualify for stimulus payments under the American Recovery and Reinvestment Act.
CMS is studying a variety of recommendations on the definitions and is expected to issue a Notice of Proposed Rule-Making in December. That will set in motion the process to develop a final rule on the meaningful use criteria for hospitals.
In his keynote at the CHIME09 Fall Forum, Blumenthal said he and his office have elevated the discussion about implementing EHRs, suggesting to professional audiences that it is an imperative for providing high-quality medical care.
"We've been having a series of conversations with professional associations and certification agencies," he said. More is involved in professional practice than collecting, storing and sharing information, Blumenthal said. "They realize that lacking the ability to process that information is not compatible with professional competence. That professional drive will overwhelm any financial incentives in promoting the adoption of IT," Blumenthal added.
Concern Over Implementation Growing
However, there's growing concern among hospitals about the challenge before them in implementing clinical record systems on a fairly fast track. Providers still are wary of how the reimbursement plan will work and whether it will be equitable.
That was exemplified by the first question Blumenthal faced from the floor at the CHIME event. Shafiq Rab, vice president and CIO at Orange Regional Medical Center in Middleton, N.Y., referred to the "cash for clunkers" car program that quickly ran out of federal money promised to consumers, and drew a correlation to providers' fears surrounding paying money upfront for expensive EHR systems in hopes of receiving government reimbursement. His plea to keep the funding plan simple and for financial support for hospitals drew a round of applause from attendees.
Blumenthal not only came to the CHIME event to speak; he also came to listen. Blumenthal had meetings with a group of CHIME member CIOs and then a sample of representatives from CHIME Foundation member firms.
"Dr. Blumenthal was seeking input from those of us on the front line of the activity," Chuck Christian, CIO at Good Samaritan Hospital in Vincennes, Ind., said, adding, "He was more interested in what we had to say rather than sharing information, and we gave him targeted feedback."
"He did not talk a lot, but let us tell him our thoughts," Randy McCleese, vice president of IS and CIO at St. Claire Regional Medical Center in Morehead, Ky., said, adding, "I think he really listened."
Included in the discussion were requests for guidance about timelines for implementation and reimbursement concerns.
More Opportunities To Weigh In
There likely will be more opportunities for CHIME members to share views and concerns on HITECH and ARRA efforts, said Pam McNutt, senior vice president and CIO for Methodist Health System in Dallas and chair of CHIME's Advocacy Leadership Team. "The lines of communication are open; that's exactly what I hoped for," she said.
While appreciative of the opportunity to talk to Blumenthal, the CIOs affirmed that the devil is in the details in devising a program that fairly and effectively encourages the use of electronic clinical systems.
"I think there is a fair amount of anxiety about the work to be done and the challenges ahead at the provider level, and yet there's also an excitement about the opportunity to enable improved healthcare," said Mike Smith, CIO at Lee Memorial Health System in Florida. He added, "My sense is that the readiness level varies by area, provider organization and vendor."
Smith is particularly concerned about the time and work needed to implement changes required to meet stimulus requirements, as well as the supporting activities that health care organizations will be facing in helping their communities with health care IT. Other concerns involve regional extension centers, which are intended to provide support for organizations that are new to health care IT and need help implementing systems.
"We also discussed issues related to alignment of state activities with the federal meaningful use guidelines and standards, and why alignment of state and federal activities is critical in order to ensure that the state efforts do not inadvertently become a barrier or challenge to a health system's achievement of meaningful use," Smith added.
Specifics Needed for Next Step
While there is general understanding of what the meaningful use criteria will look like for 2011, it's difficult for many organizations to move forward without the specifics, Christian said.
"We still don't have a clear understanding of what [meaningful use] will be and will not until the regulations are issued later this year," he said, adding, "There were those in the meeting that do not want the [meaningful use] bar set too low, as they believe that this would be of lesser benefit to those organizations that are already well on their way to full automation."
There's general consensus, and concern, surrounding the aggressive timeline laid out for meaningful use criteria for 2011 and beyond, McCleese said.
"I got the sense that he understands that the currently published requirements are too aggressive, and if I'm not projecting my own desire, I believe that we will get back a modified, more practical set of requirements," said David Muntz, CIO at Baylor Health Care System.
"I have been at the CIO level in the industry for 14 years, and we are being asked to do much more in the next six than I have seen happen in the past 14," McCleese said, noting that Blumenthal agreed with his assessment. "He understands the question, but [said] the law has been passed by Congress with good reason and we need to adhere to it."
Health care IT advocates, who have long wished for recognition of the importance of IT in improving the health care system, now have their chance, but the timelines are making many anxious.
"I have been part of HIMSS and CHIME advocacy for five years, and we have been asking for something. Now we have it," McCleese said, added, "It reflects the old saying, 'Be careful what you ask for; you may get it.' We did -- all at once."